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Ann Thorac Surg 1990;49:625-631
© 1990 The Society of Thoracic Surgeons

Articles

Controlled initial hyperkalemic reperfusion after cardiac transplantation: Coronary vascular resistance and blood flow

James K. Kirklin, MD*, Jose Neves, MD, David C. Naftel, PhD, Stanley B. Digerness, PhD, John W. Kirklin, MD, Eugene H. Blackstone, MD

Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama USA

Accepted for publication November 7, 1989.

* Address reprint requests to Dr James K. Kirklin, Department of Surgery, University of Alabama at Birmingham, UAB Station, Birmingham, AL 35294.

The coronary vascular response to controlled initial hyperkalemic reperfusion after global ischemia during cardiac transplantation was studied in 11 patients. The mean global ischemic time was 206 minutes (range, 143 to 245 minutes). All donor hearts received initial hyperkalemic crystalloid cardioplegia and subsequent oxygenated crystalloid cardioplegia during implantation. Coronary blood flow was highest during the first one to two minutes of controlled reperfusion but remained normal throughout the first ten minutes of reperfusion. Coronary vascular resistance was less than normal throughout the first ten minutes of controlled reperfusion, but then was a gradual increase throughout this period. Systemic vascular resistance remained within normal limits. The time to effective contraction was highly variable, but a greater potassium load during initial reperfusion was generally associated with a longer time to effective contraction.




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